Providing better healthcare in Afghanistan – A view from the field

Although I have extensive project management experience in Daykundi Province, the scale and impact of the System Enhancement for Health Action in Transition (SEHAT) Program is truly inspiring—for example, the 39 centers that deliver the Basic Package of Health Services (BPHS) together serve over 77,000 outpatients per month. In October 2016, these centers managed the delivery of 615 babies, with as many as 69 deliveries in Temran Basic Health Center alone.

In fact, when it comes to female health, SEHAT has ensured that there is at least one female staff member in every health center. This has partly been possible because of the successful implementation of community-level education programs, such as the Community Midwifery Education (CME) and Community Health Nursing Education (CHNE). The program has also strengthened community-based health care by setting up health Shuras (councils) in all locations covered by SEHAT and implemented specific controls on qualifications and credentials of health workers.

SEHAT is a program of the Ministry of Public Health (MoPH), supported by the International Development Association (IDA), the World Bank Group’s fund for the poorest countries, and the Afghanistan Reconstruction Trust Fund (ARTF), in partnership with multiple donors. An NGO, PU-AMI, was contracted by MoPH between 2013 and June 2017 to deliver BPHS in Daykundi, in line with national health goals outlined by the ministry. These goals include reducing mother and child deaths and improving child health and nutrition. Thus, the program focuses on increasing access, building capacity, strengthening coordination, promoting use of monitoring and evaluation data, and enabling better support for pharmaceutical supplies.

SEHAT is a very hands-on program. For example, as one of the clinics in Kiti district in Daykundi Province, a nine-hour car ride from the provincial center, had short opening times, from 8 am to 12 noon, patients from far off villages could not reach the clinic in time and were always greeted with closed gates. With SEHAT’s help, the clinic extended its opening times from 8 am to 4 pm daily.

However, what the team cannot hedge against is the harsh environment due to the climate we operated in, especially during winter. Winter used to bring a lot of specific challenges in such an environment. When roads got blocked due to snowfall, entire communities saw their access to basic services such as health disrupted and it became extremely difficult for large vehicles like trucks and ambulances to pass through, limiting supplies.

Ministry of Public Health's SEHAT Program aims to expand the scope, quality, and coverage of health services provided to the population, particularly for the poor. Photo Credit: Rumi Consultancy/ World Bank

In some very remote districts, like Ashterlay or Miramor, winter lasted for as long as six months. This is why, before we got to peak winter months, PU-AMI tried to deliver enough supplies, like food for in-patients, fuel for heating and generators, and of course medication, to help health facilities make it through the winter season. However, this process needed constant calibration. For instance, in 2016, due to an early arrival of cold winds, PU-AMI supplied fuel to ensure an optimal temperature was maintained in delivery rooms.

An operation such as the winter supply of health facilities required immense team work from different program departments—procurement, logistics, and finance. The success was always celebrated by the whole team. This was what I liked about my work. We got to ensure good health service delivery to the people of Daykundi, worked with many different partners, and witnessed the direct impact of our work on a daily basis.